CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Payclass Filters:TPIN
Eligibility Filter:Part C (excluding not eligible)
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 4 4.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 0.50 18.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 10 14.75 545.75 37.00
Subtotal (Total Children Is Unduplicated) 15 19.25 564.25 29.31
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Screening, Eval, and Assessment,Class #02
AUDE-V5090-DISPENSING FEE PER HEARING AID 2 4.00 478.40 119.60
EVAL-EVAL-DEVELOPMENTAL EVALUATION 6 22.50 1125.00 50.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 1 2.00 111.00 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 127 187.50 14062.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 7.00 525.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 66 82.00 6150.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 88 144.00 10800.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 20 28.00 1554.00 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 2 3.00 166.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 337 398.50 29887.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 31 42.50 3187.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 203 236.00 17700.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 117 147.00 8158.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 161 189.00 14175.00 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 7 8.00 388.00 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 15 15.00 727.50 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 4 6.00 291.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 10 10.00 485.00 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 6 6.00 300.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 24 26.00 1261.00 48.50
Subtotal (Total Children Is Unduplicated) 543 1564.00 111533.40 71.31
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 5 8.00 400.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 1.00 50.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 9 18.00 900.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 9 11.00 550.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 9 12.00 600.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 10 34.50 1725.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 274 2356.50 159955.52 67.88
OCCT-97530HM-OT SESSION BY OT ASST 10 52.50 2851.80 54.32
PHY-97110-PT SESSION BY LICENSED PT 245 2041.25 138370.69 67.79
PHY-97110HM-PT SESSION BY PT ASST 6 69.00 3748.08 54.32
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 1 2.00 1000.00 500.00
SENS-V5050-MED HEARING AID - ANALOG/DIGITAL 1 2.00 474.24 237.12
SENS-V5264-EARMOLD 3 8.00 149.76 18.72
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 411 3631.00 246519.28 67.89
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 4.50 244.44 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 1 7.00 92.40 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 8 196.00 98.00 0.50
Subtotal (Total Children Is Unduplicated) 639 8454.25 557729.21 65.97
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Total 10037.50 669826.86 66.73
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Number of Children (Unduplicated) With at Least One Service 962
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Center 09
Flag Claims Units Chgs Paid
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R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 364 522.00 34974.22 40817.66
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
5530 9515.50 634852.64 3036.00
Other 0 0.00 0.00 0.00
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Total 5894 10037.50 669826.86 43853.66